Facilitators and Barriers to Treatment and Harm Reduction Services for Perinatal Persons with Opioid Use Disorder in North Carolina

Abstract

Background: Opioids are effective for pain relief but pose risks of dependence, addiction, withdrawal, and overdose. Opioid Use Disorder (OUD) during the perinatal period, defined as pregnancy through the first year after birth, can lead to significant health risks for both perinatal persons and neonates, including neonatal opioid withdrawal syndrome (NOWS). Treatment options like methadone and buprenorphine and harm reduction measures such as syringe service programs and Narcan distribution aid those with OUD. They can improve maternal and neonatal health, but stigma and legal fears deter many from seeking help. Addressing barriers and improving access to treatment and harm reduction measures can enhance outcomes for perinatal individuals with OUD.

Purpose: The purpose of this study is to identify treatment and harm reduction facilitators and barriers for perinatal persons with OUD in North Carolina.

Methods: This qualitative descriptive study utilized secondary data collected in the parent study titled “Exploring Facilitators and Barriers to Harm Reduction Services in North Carolina with An Emphasis on Rural, Historically Marginalized Communities, and Pregnant or Parenting People.” Thematic analysis was used to analyze six (n=6) in-depth interviews with healthcare workers and OUD program staff in North Carolina.

Results: Analysis found facilitators to treatment and harm reduction included organizational resources, cross-sector collaborations, transportation, and building rapport with clients. Conversely, barriers to treatment and harm reduction services included lack of funding, restrictions with funds and services, and stigma and fear. Additionally, a notable finding was the lack of involvement by perinatal persons in these programs, likely due to the stigma surrounding perinatal substance use disorder (SUD) and the limited availability of perinatal-specific resources.

Discussion: This research identified several facilitators and actionable barriers to treatment and harm reduction for people who use substances in North Carolina. However, a primary finding was that few services are being provided to perinatal persons and their neonates. This research highlights the complexity of providing treatment and harm reduction services for the perinatal population and the need to develop interventions to increase treatment specifically for this population.